28 September 2012 6:29 PM

Human Psychology is not rocket science. By and large,
people do what they want to do. Politicians want power. Bankers, accountants
and lawyers want money. Teachers want long holidays. The clergy want a safe
passage into the next world. And psychiatrists and GPs want ...... Well, just
what do psychiatrists and GPs want?

To judge from their actions, in writing millions of
prescriptions each year, they want to feel that they have helped patients by
giving them mood- altering drugs such as tranquillisers, antidepressants and
sleeping tablets. Maybe they even believe in the clinical effectiveness of
these psychotropic medications. But this may be at a terrible cost to their
patients.

A recent Harvard University study, published in The
British Medical Journal, has found that pensioners who, within the last 15
years, had taken benzodiazepines – which include temazepam and diazepam – were
50 per cent more likely to develop dementia.

The researchers believe that the side effects of these
drugs may be so harmful that doctors should avoid prescribing them altogether.

Last year in
Cardiff, a study of 1,160 men aged 45 to 85 found that 9 per cent of Britons
who had taken them at least once over
the last twenty years were 60 per cent more likely to develop dementia.

And earlier this year American researchers found that
these drugs also increased the risk of early death. This study showed that even
patients taking between 4 and 18 pills a year were 3.6 times more likely to die
prematurely. Those on more than 132 pills a year were 5.3 times more likely to
die.

Professor Tobias Kurth, who works jointly at Harvard
University’s School of Public Health and the University of Bordeaux, where the
recent study was jointly carried out, said: ‘There is a potential that these
drugs are really harmful'.

I should say so. These mood-altering drugs interfere with
the function of neurotransmitters, the chemicals that transmit messages from
one brain cell to another.

Indeed they are designed to do so. Selective serotonin
re-uptake inhibitors, such as the so- called antidepressant Prozac, do exactly
that - as indicated by their name.

After a professional lifetime as a GP, and twenty three
years also running a rehab, I do not share the enthusiasm of psychiatrists and
GPs for prescribing mood-altering pharmaceutical drugs.

In sixteen years as a fully NHS doctor, eventually with a
list of 3,500 patients, I knew what it was to be flat out busy. But by
delegating medical monitoring to my nurse
and management to my secretary, I had plenty of time to spend with
patients.

Throughout my professional life as a GP (NHS or private)
I loved the work, whether it was on the estates in North Kensington and
Shepherds Bush or in the private flats and houses in South Kensington and
Chelsea. The personal problems that I heard were much the same. The psychoses
and other psychiatric illnesses were identical.

In my rehab the research studies done by a professor of
social psychology found that our patients had a higher index of psychiatric
morbidity - mental illness of one kind or another - than NHS mental hospital
inpatients. Many of our patients came from run-down areas in central London,
had desperate family and social circumstances, and a long history of
psychiatric disturbances and unemployment. We gave them the same treatment that
we gave to all our fee-paying patients but charged them nothing. We felt that
they and the fee-paying patients benefited from seeing that their addiction
problems were the same. Social circumstances made no difference to whether they
were addicts.

Addictive disease, which I believe should be named
'neurotransmission disease' because that is where an addictive nature may
originate, has three causes: a genetic predisposition in some families,
emotional trauma that sets off a craving for mood-alteration, and exposure to
substances and processes that satisfy that craving.

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25 September 2012 9:51 PM

The dangers of pharmaceutical drugs have been further
emphasised by two recent papers in the most prestigious of all medical
publications - The New England Journal of Medicine.

These reports reminded us that the global pharmaceutical
industry has been fined more than $11bn in the last three years for nothing
less than criminal wrongdoing.

There has been clear promotion of drugs for use beyond the conditions for which
they are legally licensed. Also there was evidence of Big Pharma withholding
data that queried drug safety.

Altogether 26 companies, including eight of the 10 top
companies in the global pharmaceutical industry, have been found to be
dishonest. The reports say that this has undermined public and professional
trust in the industry and that this is holding back clinical progress.

Specialist lawyers have warned that the
multibillion-dollar fines are not enough to change the industry's behaviour.
Big Pharma will take them in its financial stride.

In another report, The
Health and Social Care Information Centre of the NHS says that almost 50
million prescriptions for antidepressants were dispensed in the community (not
in hospitals or other institutions) in England last year. That amounts to just
about one prescription for every person. The total is 9.1% up on last year.

Glaxo Smith Klein, a major force in the UK pharmaceutical
industry, were hammered for mis-marketing the antidepressants Wellbutrin and
Paxil in the USA.This is a betrayal of clinical responsibility of the first
order.

So called 'antidepressants' are only 20% more effective
than placebo tablets that have no active ingredient whatever. However, they can
cause a psychological dependency and they are dangerous and sometimes fatal in
overdose.

What on earth is going on? Drugs that are largely
ineffective, but habit forming and potentially dangerous, are being marketed
and given away like sweets.

The problem stems from the belief that something has to
be prescribed when patients say that they are stressed. That is absolutely
untrue. Patients need to be heard, not pandered to and poisoned with pills.

Antidepressants will never cure, nor even alleviate,
social ills. Economic pressure, unemployment,
poor housing conditions, bereavement, domestic distress and all other
causes of personal dis-ease cannot be resolved with drugs. Prescriptions take
patients further away from being able to contribute towards resolving their
troubles. Reality has to be faced at some time.

Germans describe the 'status kranken' - the sick state in
which people abdicate responsibility for themselves. This is what is happening
here in England.

I am very sympathetic to people who are going through
difficult times. After being bankrupted and then bereaved in successive recent
years, I know a lot about stress and sadness. But I do not believe that a
deluge of drugs is the way to treat 'depression' at any level. There are more
effective ways of treating it.

We should take physical problems to doctors. They're well
trained to diagnose and treat them.

For significant emotional problems there are many skilled
non-medical professionals, some already working alongside GPs, who can spend
time with patients.

Far from trivialising the problem of depression, I am
clearly justifiably concerned that Big Pharma cannot be trusted.

24 September 2012 1:12 AM

Envy, spite and malice are no longer the exclusive
motivators of jaded Socialists. Liberal Democrats are catching up fast in the
race to take over the baton of self pity and blame.

They pride themselves on being fair and principled.
Refusal to reform parliamentary boundaries dispelled that fiction.

They are the standard bearers of local political
influence yet they sell their souls to a European superstate.

They are the avowed friends of our environment yet they
desecrate the countryside and shoreline with ugly - and inefficient - wind
farms.

Now the Anti-Business Secretary, Vince Cable, is joined
by the anti-home Financial Secretary, Danny Alexander, in pressing for extra scrutiny of people with
property and assets worth over £1m.

And their current leader, Nick Clegg, is determined to
get his mansion tax - or a tycoon tax - onto the statute books one way or
another.

Clearly they have not thought their policies through. Who
do they imagine will want to create wealth, and the employment and investment
that goes with it, if they cannot keep it securely but are expected to feel
guilty for having it?

Who will want to contribute to a society that values the
'won't do-s' over the 'can do-s'?

While politicians are forever on the take, all too often
for their own benefit either financially or in pursuit of electoral
advancement, they scorn those who contribute to the coffers that they plunder.

Further, they spend other people's money in thoughtless
and reckless ways which they might be very reluctant to copy if they were
spending their own money.

If the mansion tax now targets homes worth £2m and the
extra scrutiny, through the scarily named 'Affluence Unit' of HM Revenue and
Customs, of assets worth £1m, what would stop these thresholds being
progressively lowered?

I work hard and I have a good income. I own nothing other
than the few sticks of furniture and some pictures in my rented office. I pay
my taxes and I spend the rest on restaurants and concert tickets. I have
absolutely no intention of doing anything as self-defeating as investing or
saving. What would be the point of doing that? The Coalition, or their Labour
Party successors, would simply find new ways of confiscating anything that
belonged to me.

This is where these hair-brained policies are leading:
towards a society that is anti-ownership. We may even have reached that promised land already.

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21 September 2012 7:53 PM

As the party conference jamboree begins, we should remind ourselves that facile political philosophies can result in absolute hell on earth.

'From each according to his ability; to each according to his need' is the supposedly benign, fundamental tenet of Marxism. It is the inevitable precursor of totalitarianism.

Ability is an absolute. Needs are perceptions.

We can see very clearly when someone has ability, be it on the sports field or in business or in a profession. We depend upon such leaders. They show us the way forward.

To take from them by force diminishes their power to lead by example. Why should they bother to create, and strive to improve, when the product of their labour is first enviously scorned and then confiscated?

Why should men and women in business take financial risks, work all hours, provide employment for others and then watch while the government wastes their private resources, stolen from them by state decree?

Why should they allow themselves to be bullied by apparatchiks who have never done anything other than tick boxes?

To counter these points by saying that, in a civilised society, they would gladly give to others, misunderstands human nature. We have only to observe the self-serving behaviour of trades unionists and City traders to see that the urge to look after number one dominates everyone, throughout all levels of society.

Doctors and teachers are no more altruistic than accountants and lawyers. Elected politicians serve themselves. So do civil servants in their reluctance to give time and effort outside their contractual requirements - or even within them.

The only chance we ourselves have of benefitting from the creative inspirations and determined enterprise of others is to allow the talented to compete with each other in a free market and to get and keep their benefit from doing so.

Needs are whatever any one of us perceives them to be. The principal cause of unhappiness is when our perceived needs, and our subsequent wants, are less than our actual possessions. Envy kills us.

There is a level of subsistence that is difficult to equate with happiness and personal fulfilment. I know that: I have been there in recent years. I discovered that my real needs are very few and often inexpensive.

I consider that my principal rights are to be paid for the work that I do, to have my contracts upheld and to be treated considerately and politely. Why should I offer anything else, personally or through my taxes, to anyone else?

I shall gladly give to those who are less fortunate than I am. But I resent being emotionally blackmailed into doing so by politicians, the clergy or by social workers and others in the dependency industry. In particular, I resent being forced to give to the state - especially when it takes the credit for giving away my money to its selected recipients.

Far from signing up to Marxism, I gladly adhere to Ayn Rand's Objectivist Oath: 'I swear, by my life and my love of it, that I shall never live for the sake of another man, nor ask another man to live for mine'.

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17 September 2012 8:39 PM

The Conservative Party conference will demonstrate just one thing: Boris Johnson has to be the Conservative leader if the party is to stand any chance of electoral success.

Interestingly, the conferences of the Labour Party and Liberal Democrat Party will demonstrate the same thing: Boris Johnson is the only senior politician who is widely liked and respected in the country.

We like him, despite all manner of idiosyncrasies and misbehaviours - and perhaps even because of them. He has the common touch, despite having a privileged background .

In political circles he is dismissed as being lightweight. We are told that running a country is very different from being Mayor of London or waving a flag for the Olympics and Paralympics.

Maybe so but the public trust Boris and we doubt that he could do any worse than anyone else. We even believe that a country run by Boris might be rather fun and we could certainly do with some of that.

But would he be capable of making sensible decisions on important subjects? You bet he would. He is exceptionally able, as bright and sharp as can be. He hides these assets because generally they are not particularly attractive features in politicians, even though they are very necessary in high office.

William Hague, Iain Duncan Smith and Michael Gove have similar intellectual skills but, popular though these men are in the Conservative Party, they do not have the wider appeal of Boris in the country.

The fact that Mr Johnson is known so well by his first name is not simply because it is distinctive but because people are genuinely fond of him. We laugh with him, not at him as we do at many other politicians.

These are huge electoral assets, as he has twice demonstrated in the elections for Mayor of London, which is largely a Labour stronghold.

The Conservative Party needs a winner but, more significantly, so does the country. The main party conferences will prepare the ground. Nobody but Boris will attract significant public interest. The Council elections next May will clarify the national despair with the body politic. This will make Boris Johnson's future premiership imperative.

14 September 2012 7:45 PM

President Reagan said that the most frightening words in
the English language are, "I'm from the government: I'm here to
help".

Professor Martin Jarvis, from University College, London,
says in the online journal BMJ Open, that
our government's current guidelines on alcohol consumption "may not
be compatible with optimim protection of public health".

He says that cutting average alcohol consumption to less
than half a glass of wine a day would save more than 4,500 lives in England.

I'm surprised he did not mention, as health care pundits
usually do, the savings that would be made to the NHS. Perhaps he realises that
these would be illusory: people who do not die cost more to care for, not less.

Prof Jervis is disingenuous in failing to emphasise that
10% of the population drink 50% of the alcohol consumed. If that 10% were to
drink only half a glass of wine a day, they would go up the wall. They may well
be alcoholic and the one thing that alcoholics cannot do is to drink sensibly.
The first drink in any day triggers the craving for the next. They need the
support of Alcoholics Anonymous to enable them to be totally abstinent and
comfortable in their abstinence.

What concerned President Reagan was the dependency
culture. Paul Ryan, Mitt Romney's choice for Vice President in the USA
elections this November, is equally concerned.

If people become dependent on the state for health care,
it is only a matter of time before they become totally dependent. They come to
believe that the state is absolutely indispensable.

Any reduction in state provision is then seen as a wicked
'cut', rather than as a sensible precaution against the entire national economy
being sucked into a bottomless pit.

I have no reason to doubt the figures that Prof Jervis
has produced from a new mathematical model that looked at 11 medical conditions
that are known to be associated with a high alcohol consumption.

One important conclusion from this study is that moderate
alcohol consumption does not protect against heart disease. This will take away
the alcoholic's rationalisation that drinking alcohol in moderation (as he or
she would define that) is good for you.

But again, the study looks at averages rather than
individuals. There may be some protective effect in some people, just as some
people have a tendency to alcoholism and others do not.

This is really the crucial issue. Instead of seeing us as
all the same, we need to identify those who are particularly at risk. After
all, we do that for cancer and heart disease and diabetes and many other
clinical conditions. Only for alcoholism and drug addiction, and other forms of
compulsive behaviour, are the mandarins of The Department of Health and their
advisors reluctant to say that there might be a genetic component that makes
some people particularly vulnerable.

The reason for that refusal to face the obvious is
financial, as one would expect from any government department. If alcoholism
really is accepted as a disease, as it is by The World Health Organisation,
rather than as a depravity or a weakness of will, then the Department will have
to get serious about identifying it and doing something about it.

And that will turn the statistics of Prof Jervis and his
colleagues completely upside down.

Maybe then we can all be treated as individuals rather
than as mere numbers in the Grand Design of the state.

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12 September 2012 8:33 PM

"If you're not a Socialist before 30 you have no
heart. If you're still a Socialist after 30 you have no head."

This old saying is not true. There are many highly
intelligent Socialists who stayed true to their political beliefs into a ripe
old age.

It isn't so much that they are unintelligent as just
plain wrong.

The same could be said for those who have religious
belief or any number of other fixed convictions.

An open mind does not depend upon intelligence. It is a
concommitant of curiosity. Closed minds look for an ultimate solution (which we
should know from Douglas Adams is 42). Open minds take delight in the next
question.

The fundamental basis of scientific statements is that
they should be disprovable. This is why politics is not a science.

However, the generalisation "It's the economy,
stupid" applies to individuals as much as it does to presidential or prime
ministerial candidates.

Young people generally have nothing. Therefore they tend
to be attracted by an entitlement culture. By the time they have possessions of
their own, they are more persuaded by political philosophies that enable them
to justify keeping them. Champagne Socialists try to get the best of both
worlds.

My own experience is that I have stayed fairly constant
in the values and principles given to me by my parents and guardians. What has
changed is my view on how they can best be put into practice.

In my twenties I was an active member of the North
Kensington Labour Party. But the local party became heavily influenced by
Trotskyites and the national party moved away from Hugh Gaitskell and towards
Harold Wilson, Michael Foot and Tony Benn.

So I moved to the Liberal Party of Jo Grimond and Jeremy
Thorpe. But the individualism that attracted me disintegrated into
collectivism. I had already put that behind me once. Now I had to do so again.

I was much attracted by Margaret Thatcher's free market
ideas that enabled individuals to prosper through hard work, rather than be
smothered by government diktats.

But her political assassination, and the grey eminences
that followed her distinguished premiership, inevitably disillusioned me yet
again. I became a Libertarian.

I stayed with those concepts but became uncomfortable
when some adherents of Libertarianism were clearly nuts. That is true of some
members of all political persuasions but total freedom to use drugs, or have
sexual adventures with partners of any age, was not something I could go along
with.

I toyed with the idea of voting for Tony Blair, thinking
that he most represented the beliefs of my childhood. His successor, Gordon
Brown - and, even more so, Ed Miliband - have reminded me that I had left Socialism
behind for very good reasons.

Now, with David Cameron's choice to form a coalition with
The Liberal Democrats, rather than be the head of a minority Conservative
administration, I am back to the start.

If I were to be a member of a political party again, I
can see little choice other than to consider joining UKIP. But I fear that this
would put me alongside some strange bedfellows, although not of the precise
nature as those I had found in Libertarianism.

Repeatedly, I have the feeling that "None of the
above" would most represent my views..

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11 September 2012 9:47 PM

London, New York and Paris are the only places in the
world that I would want to live in. They are large enough to have everything,
although in some areas there are more negatives than positives.

New York, as with
the rest of America, has the most of everything, as well as many of the very
best. It has Life with a capital 'L'. But it can be too frenetic.

Paris has everything too but, as even the French
themselves acknowledge, its problem is the Parisians. French bureaucracy is
also tedious.

London has the best of all worlds. We have all the arts
facilities that our hearts could ever desire, terrific sports grounds,
wonderful shops, international cuisine, lovely parks and impressive historical
buildings.

We may gripe about our politicians and our economic woes
but so can almost anyone else. But, especially for the privileged although not
exclusively for them, London is absolutely fabulous.

On a smaller scale, Barcelona takes a lot of beating not
only in football. Watching the Barca/Valencia match from just above the players
tunnel was very special. Any time spent in the Gaudi Cathedral of the Sacred
Family is heaven sent.

So is any time spent in the Arts Hotel, when our bedroom
windows look towards the cathedral and the mountains in one direction and the
great sail of The World Trade Centre and the sea in the other.

Three concert productions of Wagner operas in consecutive
nights, by the Bayreuth opera company, at the beautiful Liceu Theatre in Barcelona
is also fully joined up living in my way of thinking, To experience so much of
the best in the world in just one week in one place seems to me to be exactly
what my wife, Pat, and I should be doing socially on a delayed honeymoon -
which is what we were doing. After all, I married the best in the world.

07 September 2012 6:55 PM

Our new Health Secretary, Jeremy Hunt, needs to look at
ideas as well as numbers and vested interests.

He should listen to Paul Ryan, Mitt Romney's choice for
his vice presidential candidate in the USA elections, who has expressed
concerns over the ideas upon which the NHS is based.

My Ryan says that "Once a large number of citizens
get their health care from the state, it dramatically alters their attachment
to government. Every time a tax cut is proposed, the guardians of the new
medical-welfare state will argue that tax cuts would come at the expense of
health care."

He is absolutely right.

If the state takes over ultimate health care
responsibility from the individual, there are inevitable consequences:

Individuals come to think that they have rights, and
hence can demand a service without at the same time having to recognize that
the service is inevitably the product of the life and work and integrity of
someone else.

Any thinker who allows himself or herself to be the
property of someone else ceases to think. Doctors who allow themselves to
become mere units in state provision of health care, rather than people who are
responsible for their own philosophical and mental integrity, are not worth
asking the time of day let alone their opinions on clinical or personal
problems.

People often assume that the state will care for the less
fortunate. When presented with evidence that it does not do so, they complain
that it should – but do not feel obliged to take any positive helpful action
themselves.

Thus the state is the cause of the Inverse Care Law,
whereby those most in need of help are least likely to get it. The state
creates a cruel, arid, uncaring society that smothers individual compassion and
human charity.

The state cannot be relied upon to produce responsible
clinical care at the time that it is needed.

A true sense of commitment can only be the product of an
individual mind and personal philosophy. It can never be instilled by rules,
regulations and committees.

If resources are distributed according to need:

People compete with each other to establish their need
rather than their capacity to do well on their own account.

The individual demands his or her so called ‘rights’ without
any thought that it is at another’s expense.

The corporate body, answerable for its expenditure of
public funds, spends its budget up to the hilt – or even overspends regardless
of the needs of others – so that it can demand the same again or even more the
following year.

Little attention is paid to the capacity of the recipient
to benefit from the resource. An absolute need may be totally unchanged even
after all the resource has been devoured. Meanwhile someone else with a lesser
objective need is left with no possibility of the benefit that could have been
his or hers because the resource has in effect been squandered.

Scientific assessment of benefit takes second place to
the repetitive, mindless, arrogant hollerings of political pressure groups.

If services are free at the time of need:

Perceived needs become relative rather than absolute.
Meeting a need does not satisfy: it merely shifts attention to another need.

Instead of the individual patient not being able to
afford treatment, the state runs out of money so that either the individual
cannot get treatment at all or, alternatively, the treatment that he or she can
get is not worth having.

The proponents of the system point to a few people who
have been dramatically helped ‘at no cost’.

They play on the fear or pity of their listeners – and in
so doing make them into supplicant pap.

Also, they disregard what is happening in general to the
NHS by focusing upon a few fortunate patients in particular.

The state comes in time to be thought to be indispensable
and with that goes every last individual freedom.

If the ideas and principles of the NHS are wrong then the
practice will inevitably fail. True compassion can only be individual.

If I choose to help you or not, that is my affair but I
shall reap the consequences. I have to earn my place in a compassionate society
through my actions for others.

By contrast, the state can never be compassionate. When A
gives the life of B for the benefit of C, but A expects the credit for himself
or herself, this is the essential prerequisite for totalitarianism.

This is why Ayn Rand, the author of Atlas Shrugged, which
Paul Ryan recommended his staff to read, is right when she says that the
difference between a welfare state and a totalitarian state is only a matter of
time.

I first formulated these ideas in 1980 but nobody would
publish them. The NHS was a sacred cow, as it clearly still is for Danny Boyle,
who produced the opening ceremony for the Olympics, and many others.

Now that the NHS brand is to be sold around the world, we
may find that there will be no takers.

After all, the NHS has existed for over sixty years but
no other country has copied it. Clearly it is not the envy of the world.

A system that does not work in practice is a bad system,
however virtuous it may superficially appear to be in theory.

We need Paul Ryan here to give us all, including Jeremy
Hunt, a stiff dose of reality.

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05 September 2012 2:11 AM

Government re-shuffles are not of great interest to the
public at large. The political class has become progressively more alienated from
the electorate. 'None of the above''
would win any election by a landslide.

I was taught that politics is the stuff of life. It still
is - but perhaps only for politicians, bureaucrats, jobsworths and quangocrats.

I have always been a political animal. I was brought up
by Michael Stewart, a fine man and a consummate politician. He wanted the best
for the world, not for himself.

Apart from Frank Field, Gisela Stuart, William
Hague, Michael Gove and Ian Duncan
Smith, I can think of no politician with whom I would be proudly associated
today.

'The Great and the Good', a term used to describe the
quango coterie, is an oxymoron if ever there was one. They may have been great
and good before they were given the power to advise and control - but that goes
to their heads in double-quick time.

Civil Servants are still civil but 'servants' ? - Never.
They look after themselves and their pensions.

Nowadays, I am
closer to the protest movements than I am to The Establishment.

By the time someone with my background becomes
disillusioned with the body politic, we really are in trouble. I have always
been keen to find better ideas. No longer, except in my daily work. Innovation
would simply be steamrollered into the ground by the state juggernaut.

I am equally disillusioned by bankers and multinational
companies. These bastions of capitalism are just as corrupt and self-serving as
their statist counterparts.

Schumacher was right: small is beautiful. It is also more
effective. The disastrously expensive and destructive fiasco of the european
super-state illustrates that each day.

In the microcosm of my own life, I have never been
happier in my professional life than I am now, working entirely on my own,
rather than running a large organisation.

I have no staff to train, supervise and pay for. I am not
hounded by officials who have never themselves created or run anything
whatever. They usually ticked all their boxes on my services but I take no
pride in that. I do not value their judgement.

Our society is fractured. It is dying. It needs less
government, rather than more. Even bankers and multinationals would come to
heel in markets that are totally free from state protection.

If our present set of politicians can't see all this, and
do something about it, 'None of the above' should be given a chance.

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DR ROBERT LEFEVER

Dr Robert Lefever established the very first addiction treatment centre in the UK that offered rehabilitation to eating disorder patients, as well as to those with alcohol or drug problems. He was also the first to treat compulsive gambling, nicotine addiction and workaholism.
He identified 'Compulsive Helping', when people do too much for others and too little for themselves, as an addictive behaviour and he pioneered its treatment.
He has worked with over 5,000 addicts and their families in the last 25 years and, until recently, ran a busy private medical practice in South Kensington.
He has written twenty six books on various aspects of depressive illness and addictive behaviour.
He now provides intensive private one-to-one care for individuals and their families.

He has written twenty six books on various aspects of depressive illness and addictive behaviour.

He now uses his considerable experience to provide intensive private one-to-one care for individuals and their families.